Utilization of APPE Students in Electronic Rounds for Joint Commission Core Measures for Stroke Therapy in a Community Hospital Amber M. Hutchison, PharmD, BCPS Assistant Clinical Professor Auburn University Harrison School of Pharmacy

Joint Commission Core Measures The Joint Commission is a not-for-profit organization –The accrediting body for many health-care organizations National quality measures developed by the Joint Commission and the Centers of Medicare and Medicaid Services –Data on measure compliance is provided for quality information to the public The Joint Commission [homepage on the Internet]. Illinois: The Joint Commission; c2013 [updated 2013; cited 2013 June 9]. Available from:

Core Measures Examples of current core measures: –Venous thromboembolism –Acute myocardial infarction –Heart failure –Surgical care improvement project –Pneumonia –Children’s asthma care Specifications Manual for National Hospital Inpatient Quality Measures –Lists accountability measures –Defines data elements The Joint Commission [homepage on the Internet]. Illinois: The Joint Commission; c2013 [updated 2013; cited 2013 June 9]. Specifications Manual for National Hospital Inpatient Quality Measures. Available from: t_quality_measures.aspx t_quality_measures.aspx

Stroke Core Measure List Venous thromboembolism prophylaxis Discharged on antithrombotic therapy Anticoagulation therapy for atrial fibrillation/flutter Thrombolytic therapy Antithrombotic therapy by end of hospital day 2 Discharged on statin medication Stroke education Assessed for rehabilitation

Practice Setting East Alabama Medical Center –340 bed acute care regional referral hospital –Preceptor covers hospitalist service on a medical telemetry floor –1-2 advanced pharmacy practice students per rotation block

Electronic Stroke Rounds Prepared by an RN who functions as an Improvement Specialist Completed Tuesdays and Thursdays Assembled based on information provided by case managers List is ed to a group which includes pharmacists, case managers, dieticians, and therapists –Once reviewed, an update on patients is sent back to the group

Preparing Students for Stroke Rounds Integrated Pharmacotherapy course –Problem-based learning course utilizing team- based learning –Acute ischemic stroke case: includes introduction to Core Measures APPE rotation –Orientation to computer systems –Topic discussions –Review of standardized patient monitoring sheet

Topic Discussions Have utilized: –Review of current stroke management guidelines –Pharmacotherapy Self-Assessment Program chapter for Management of Acute Ischemic Stroke and TIA Explanation of Specifications Manual for National Hospital Inpatient Quality Measures –Core Measure lists –Alpha-data dictionary

Patient Monitoring Sheet Three patients per sheet Includes elements for Joint Commission stroke Core Measures Extra elements not evaluated by Core Measures but good practice –Blood glucose control –Blood pressure control

Students Completing Stroke Rounds Preceptor receives list in the morning –List consists of both hemorrhagic and ischemic stroke patients Students divide up the list and have the afternoon to review patients –Students contacts preceptor for urgent matters Patients are presented to the preceptor the next day –Monitoring sheet guides presentation

Students Completing Stroke Rounds Students and preceptor discuss possible interventions and decide best course of action Physicians are contacted via phone, note in chart, or in person Interventions are documented in Quantifi® Stevenson TL. Am J Pharm Educ. 2011; 75(5): 90.

Common Interventions Initiation of statin therapy Venous thromboembolism prophylaxis initiation Antithrombotic recommendations –Prevention of dual/triple antiplatelet therapy Lipid panel ordered Blood pressure management recommendations

Stroke Rounds Over a 12 month period –399 chart reviews were performed 5.4 patients reviewed per rounding session –276 individual patients 146 patients reviewed by Stroke Team met criteria for Core Measure evaluation after discharge –44 interventions made 18.5%: initiated statin medication 8.2%: optimization of antithrombotic therapy

Ideas for Incorporating Students for Core Measures Determine which Core Measures are monitored by your facility Reports can be built to help determine which patients should be reviewed Develop a “quick rounds” sheet targeted at your measure Incorporate introduction to this process during orientation